Provider Demographics
NPI:1861534026
Name:VISTE, JOSEFINA BILLEDO (MD)
Entity type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:BILLEDO
Last Name:VISTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3111
Mailing Address - Country:US
Mailing Address - Phone:213-386-0010
Mailing Address - Fax:213-386-4190
Practice Address - Street 1:2721 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3111
Practice Address - Country:US
Practice Address - Phone:213-386-0010
Practice Address - Fax:213-386-4190
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A388150Medicaid
CA00A388150Medicaid